WKYT Investigates: How doctors determine a COVID-19 death

WKYT Investigates: How doctors determine a COVID-19 death
Published: Dec. 7, 2020 at 2:08 PM EST
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LEXINGTON, Ky. (WKYT) - This never gets easier to say, nine months into the pandemic, and Kentuckians continue to die. COVID-19 has killed more than 2,000 in the commonwealth.

More than 100 were Fayette Countians. As of December 1st, 89 were patients at UK Hospital.

There is frustration that comes with those deaths and, with some, confusion about how a relatively new virus can kill so many, so differently.

“The majority of the people across the country who are dying of COVID are people who are elderly and have comorbid conditions,” said Dr. Ashley Montgomery, University of Kentucky HealthCare.

Dr. Montgomery works in the COVID ICU at UK. When one of her patients passes, the fellow resident, physician in training, PA, or nurse practitioner begins the notification of death. The attending physician then validates it and the Kentucky Department of Health then gets it.

“When we look at cause of death, it is the immediate things that brought you into the hospital,” Dr. Montgomery said.

With so many dying from such a relatively new virus, there is some confusion on what’s considered a COVID death. Especially, Dr. Montgomery says, when you take into account comorbid conditions.

“It could be that they have a cancer diagnosis. It could be that they have lung disease like COPD or emphysema from smoking,” Dr. Montgomery said. “It could be that they have diabetes. It could be that they have what we call peripheral vascular disease, just poor vasculature refusing the rest of their body. It could be that they have high blood pressure. It could be that they have kidney failure or liver failure, or cirrhosis, those sorts of things.”

Those can play roles, big roles, in a patient’s death, but the state will still list COVID as a cause if a physician determines a progression from a positive COVID-19 test to death.

“In order for something not to be related to the death, the patient needs to recover fully. If you had COVID in March and you went home and you went back to work and were doing completely fine and in August you have a stroke, well then we wouldn’t equate the COVID to that,” Dr. Montgomery said. “But if you had the stroke while you were in the hospital critically ill with COVID we would say, ‘well that did lead to that death, and it is part of the death.’”

Patients with comorbidities, that’s one or more illnesses when diagnosed with COVID, are less likely to survive. And that’s where more confusion comes in.

One woman from Clark County talked to us about the frustrations she felt when her mother’s death was listed as COVID, nothing more, even though the 91-year-old had been battling several illnesses before coronavirus.

“Even a super healthy 85-year-old is not going to do well on a ventilator, but an unhealthy 60-year-old may not do well on a ventilator, and the things that we can do to help our own families and our own communities are eat healthy,” Dr. Montgomery said. “Maintain a healthy weight. Stay active. If you have a chronic condition, maintaining those sort of goals that we’ve set as a medical community because we know that if you can keep your diabetes at the right level, if you can keep your blood pressure at the right level, then you have less chronic damage to your organs and thus when you have an acute injury whether it be a car wreck or a stroke or an infection you’re gonna have a better chance of responding, healing, and going home to be with your loved one.”

And less likely to end up on the governor’s list.

The Cabinet for Health and Family Services has a mortality review committee that looks at deaths. They determine what role COVID played in a COVID-positive patient’s death.

For the majority of cases, cabinet leaders say the physician or the coroner determines the cause.

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